Definition and Meaning of the 2018 PA POLST
The 2018 Pennsylvania Provider Orders for Life-Sustaining Treatment (POLST) is a medical form that provides explicit directions regarding patient preferences for life-sustaining treatments. It serves as a legally recognized document, enabling emergency medical personnel to quickly understand and respect a patient’s treatment preferences, especially during critical situations where the patient may not be able to communicate. The form encompasses directives for resuscitation, the use of medical interventions, and other supportive measures such as nutrition and hydration.
How to Use the 2018 PA POLST
Using the POLST involves several key steps:
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Discussion: The process starts with an in-depth conversation between the healthcare provider and the patient or their surrogate decision-maker. During this discussion, the patient's values, goals, and treatment preferences are clarified.
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Completion: A healthcare provider completes the form based on this discussion. The form details specific instructions regarding the desired level of medical intervention in various scenarios.
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Signature: To validate the POLST, it must be signed by both the patient (or surrogate) and the physician. This joint signature ensures that the patient’s wishes are clearly communicated and agreed upon.
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Accessibility: Once completed, the POLST should be easily accessible, whether at home, in a medical facility, or during transit, to ensure that EMS providers can follow the directives.
Steps to Complete the 2018 PA POLST
Completing the 2018 PA POLST requires careful attention:
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Personal Information: Begin with accurate details about the patient, ensuring that identification is clear.
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Medical Orders: Specify the patient's preferences for resuscitation (CPR vs. DNR), full treatments vs. comfort measures, and other medical interventions.
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Additional Directives: Include instructions on medically assisted nutrition such as feeding tubes if applicable.
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Consultation Review: Discuss any concerns or questions during a consultative review with the healthcare provider.
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Review and Sign: Ensure all necessary parties review the content for accuracy before obtaining required signatures.
Key Elements of the 2018 PA POLST
Key elements include:
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CPR Orders: Indicates whether or not the patient opts for resuscitation if they stop breathing or their heart stops.
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Medical Interventions: Options vary from full aggressive treatments to selective or solely comfort-focused care.
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Nutrition and Hydration: Details the patient’s choice regarding artificial nutrition and hydration interventions.
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Signatures: Validity requires signatures from the physician and the patient or their legal surrogate.
Who Typically Uses the 2018 PA POLST
The POLST is typically used by patients with serious illnesses or frailties for whom a sudden medical event could quickly lead to a life-ending situation. It is also employed by:
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Elderly Patients: Particularly those in hospice or long-term care.
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Health Care Providers: Doctors, nurses, and EMS personnel rely on it to guide immediate care decisions.
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Patient Advocates and Caregivers: To ensure that the patient's preferences are followed when they cannot advocate for themselves.
Legal Use of the 2018 PA POLST
In Pennsylvania, the legal framework integrates the POLST into medical decision-making. Key legal aspects include:
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Recognition: The POLST is a legally binding document once it is properly filled out and signed.
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Surrogate Decisions: When patients cannot sign, a legally appointed surrogate can do so, ensuring patient autonomy is respected.
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Compliance Requirement: Medical personnel are required by law to comply with the instructions within the POLST when presented in emergency scenarios.
State-Specific Rules for the POLST
In Pennsylvania, there are specific regulatory nuances:
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Colored Forms: Although Pennsylvania suggests using a bright pink form for visibility, any color copy is valid as long as it is completed correctly.
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Review Cycle: It’s encouraged that the POLST be reviewed periodically or whenever there is a change in the patient's health status, care setting, or treatment preferences.
Examples of Using the 2018 PA POLST
Consider the following scenarios:
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Emergency Room Application: An elderly patient with a POLST is rushed to the ER. EMS complies with the DNR order indicated on the POLST rather than attempting CPR.
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Nursing Home Transition: A patient transitioning to hospice care may update their POLST to focus on comfort measures only, ensuring that the new care team is fully informed of their wishes.
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Cross-state Travel: A Pennsylvania resident traveling to another state presents their POLST to ensure continuity of care decisions, although checking that other states may have different recognition processes.
In each scenario, the POLST provides clear, authoritative guidance that aligns medical intervention with personal preferences, supporting dignified and personalized care.
